Browsing by Author "Otaola, Hugo"
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Item A prospective randomized study comparing bipolar plasmakinetic transurethral resection of the prostate and monopolar transurethral resection of the prostate for the treatment of Benign Prostatic Hyperplasia: efficacy, sexual function, Quality of Life, and complications(2021) Otaola, Hugo; Álvarez, Manuel; Molina, Roberto; Fernández, Mario; Páez, ÁlvaroObjective: To generate high-quality data comparing the clinical effi cacy and safety profi le between monopolar transurethral resection of the prostate (M-TURP) and bipolar plasmakinetic resection of the prostate (PK-TURP) for benign prostatic hyperplasia (BPH). Materials and Methods: Prospective, randomized, single-blinded study conducted in a tertiary-care public institution (Dec/2014-Aug/2016). Inclusion criteria: prostate of <80g in patients with drug-refractory lower urinary tract symptoms (LUTS), complications derived from BPH, or both. Exclusion criteria: a history of pelvic surgery/radiotherapy, neurogenic bladder dysfunction or documented/suspected prostate carcinoma. Treatment effi cacy evaluated at 1, 3, 6 and 12 months. Effi cacy outcomes: international prostate symptom score (IPSS), quality-of-life (QoL) score, international index of erectile function-5 (IIEF-5), maximum urinary fl ow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed with parametric/non-parametric tests. Results: Out of the 100 hundred patients, 84 qualifi ed for the analysis (45 M-TURP/39 PK-TURP). No signifi cant differences found in baseline characteristics or operative data, except for a longer operative time in PK-TURP (MD:7.9min; 95%CI:0.13-15.74; p=0.04). No differences found in IPSS, Qmax or PVRU volume. QoL score at 12 months was higher in PK-TURP (MD:0,9points; 95%CI:0.18-1.64; p=0.01). No differences in sexual function, PV, complications or sequelae were found. This study is “rigorous” (Jadad- scale) and has a low risk of bias (Cochrane-Handbook). Conclusions: Based on this controlled trial, there is not signifi cant variation in effectiveness and safety between M-TURP and PK-TURP for the treatment of BPH. The small difference in QoL between PK-TURP and M-TURP at the one-year follow-up is not perceivable by the patients and, therefore, not clinically relevant.Item Deferasirox y Tubulopatía Proximal Compleja. Presentación de dos casos clínicos(2021) Niño, Carmen; Cervera, Áurea; Otaola, Hugo; Sevilla, Julián; Aparicio, CristinaIntroducción: El tratamiento con quelantes de hierro es fundamental para los pacientes con sobrecarga férrica se cundaria a transfusiones a repetición. Deferasirox es el primer quelante del hierro activo por vía oral de una sola administración al día. Gracias a ello, la adherencia terapéutica ha mejorado, disminuyen do las complicaciones derivadas de la sobrecarga de hierro, especialmente la insuficiencia cardiaca. Sin embargo, no está exento de posibles efectos secundarios, como la afectación renal, siendo esta complicación más frecuente en niños. Objetivo: Comunicar dos pacientes con anemia de Blackfan-Diamond (ABD) que desarrollaron afectación de la función renal secundaria a la administración de Deferasirox. Casos Clínicos: Caso clínico 1. Adolescente de 15 años diagnosticada de ABD en trata miento con transfusiones periódicas y Deferasirox. En el contexto de una gastroenteritis aguda, de sarrolló insuficiencia renal aguda junto con tubulopatía proximal compleja. Caso clínico 2. Niño de 5 años diagnosticado de ABD, por lo que recibe transfusiones periódicas y tratamiento con Deferasirox. Presentó cuadro de poliuria con alteraciones analíticas compatibles con insuficiencia renal aguda y disfunción del túbulo proximal. En ambos casos se realizó una adecuada hidratación y suspensión de Deferasirox transitoriamente, con mejoría de la función renal. Conclusión: Basados en esta experien cia, se recomienda realizar una monitorización estrecha de la función renal y tubular, así como de los niveles de ferritina, en los pacientes en tratamiento con Deferasirox. Ante procesos intercurrentes, se debe realizar una hidratación adecuada y considerar una reducción precoz de la dosis o la interrup ción del fármaco en los casos de afectación renal.Publication Fibromuscular Dysplasia of the Coronary Arteries: An Infrequent Cause of Sudden Death(2022) Niño, Carmen; Otaola, Hugo; Lara, Natalie; Palavecino, Carla; Veloso, Luis; Riquelme, MaryelSudden cardiac death (SCD) is defined as a sudden and unexpected death secondary to a cardiovascular cause. In many cases, cardiopulmonary resuscitation (CPR) maneuvers can achieve recovery of the patient, which is then called resuscitated SCD. We present the case of an adolescent with resuscitated SCD, who finally died of refractory cardiogenic shock, secondary to fibromuscular dysplasia of the coronary arteries.Publication Impact of insufflator/aspirator versus exclusive insufflator during robotic radical prostatectomy: a comparative prospective cohort study(2023) Otaola, Hugo; Mejías, Orlando; Bravo, Juan; Pinochet, Rodrigo; Bernier, Pablo; Muñoz, Lorena; Orvieto, MarceloBackground: New generation devices that combine high-flow insufflation with smoke aspiration using continuous gas recirculation ]so-called Insufflator/aspirator systems (IAS)] have recently been developed to generate pneumoperitoneum. The use of an IAS could have an impact on surgical compared to conventional insufflation systems (CIS). The present study aimed to compare the clinical effectiveness/safety, healthorganizational, and pathological/oncological outcomes of the CIS versus IAS during robot-assisted radical prostatectomy (RARP). Methods: Comparative retrospective cohort study including patients with non-metastatic prostate cancer treated with RARP by four expert surgeons at a robotic referral centre between January 2020 and December 2021. A CIS was used until 15 March 2021, and the IAS thereafter. Data were extracted from the Institutional Review Board-approved (#1064) retro and prospective institutional database. Results: The final analysis included 299 patients (143 CIS; 156 IAS). We found no statistically significant differences in demographic data and preoperative results, allowing adequate group comparison. The rate of complications of any degree (9.1% and 1.9%, P<0.05) and major complications (4.2% and 0.6%, P<0.05) were lower in the IAS group. Accordingly, the hospital stay was shorter in the IAS group (P<0.05); however, the small size of this statistically significant difference probably lacks clinical value (1.9±1.6 vs. 1.6±0.8 days). There was no significant difference in surgical time, bleeding, pathological findings, or oncological results. Conclusions: Data from this large group of patients showed that the rate of overall complications, the rate of major complications, and the length of stay were lower in the IAS group. Implementing the IAS in RARP patients increased the occurrence of SCE and affected our daily practice of transversus abdominis plane block. Interpretation of the results should be made with caution since the design of this study did not allow for the identification of a causal relationship.Publication Intranodal Ultrasound-Guided Percutaneous Methylene Blue Injection for the Identification of Leakage Point during Laparoscopic Repair of Refractory Chylous Ascites after Laparoscopic Lymphadenectomy for Kidney Cancer(2022) Otaola, Hugo; Vargas, Patricio; Hasson, Daniel; Orvieto, Marcelo; Niño, Carmen; Bermúdez, HugoChylous ascites is an uncommon complication after surgery that can result in malnutrition and immunodeficiency. Therefore, surgical interventions are reserved for refractory patients, and the primary success factor for these interventions is locating the point of leakage, which is often tricky. We describe a case of a 56-year-old male with chylous ascites after laparoscopic radical nephrectomy and lumbo-aortic lymphadenectomy for kidney cancer. The patient was initially managed with dietary modifications and drainage placement. Afterward, lymphography with Lipiodol, percutaneous embolization of the leakage point, and total parenteral nutrition were established. Finally, the patient underwent laparoscopic repair after identifying the leakage point by injecting methylene blue through an inguinal node. Complete resolution was achieved, and no complications related to the procedure were recorded. Intranodal methylene blue injection can be an invaluable tool to identify the point of leakage in selected patients to improve the outcomes of surgical repair of refractory chylous ascites.Item Long-Term Oncological and Functional Outcomes After Robot-Assisted Partial Nephrectomy for Clinically Localized Renal Cell Carcinoma(2022) Otaola, Hugo; Krebs, Alfred; Bermúdez, Hugo; Lyng, Raúl; Orvieto, Marcelo; Stein, Conrado; Labra, Andrés; Schultz, MarcelaBackground: To evaluate long-term oncological and renal function outcomes in patients treated with robot-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC). Patients and methods: Patients undergoing RAPN for clinically localized RCC between January 2014 and December 2019 at a tertiary robotic reference center were evaluated. Clinical course, pathologic characteristics, and long-term outcomes were obtained from our institutional review board-approved RCC database. Results: A total of 234 patients were available for analysis. Median follow-up was 46 months (10.8-97.8 months), with 77 patients (32.9%) having at least 5-years of follow-up. Pathology revealed clear-cell RCC in 67.5% (n = 158). Among unfavorable factors, nuclear grades 3 or 4 were found in 67 (29.4%), lymphovascular invasion in 10 (4.3%), positive surgical margins in 22 (9.4%), necrosis in 21 (9%), and sarcomatoid pattern in 2 patients (0.9%). At 12 months, mean serum creatinine was 1.04 mg/dL and 12.9% of patients experienced upstaging in chronic kidney disease. Overall recurrence-free survival at 5-years was 97.8%. There were five local (2.1%) and two distant (0.9%) recurrences, none of them resulting in cancer-specific death. Median time to recurrence was 20 months (11-64 months). Warm ischemia time [hazard ratio (HR) = 1.14, p = 0.034] and sarcomatoid pattern (HR = 124.57, p = 0.001) were the only variables associated with local relapse. Conclusions: Data from this large cohort demonstrate that patients undergoing RAPN have a low incidence of local and distant relapse, resulting in excellent long-term survival while preserving stable renal function in most patients.Item Malignidad de las lesiones renales bosniak iii-iv. utilidad de la nueva clasificación bosniak(2021) Labra, Andrés; Otaola, Hugo; Barroso, Julio; Araneda, I.; Cifuentes, C.Introducción: La propuesta de actualización de la clasificación Bosniak 2019 para las lesiones quísticas renales incorporó nuevos criterios y su aplicación en Resonancia Magnética. El objetivo es evaluar la proporción de malignidad en las lesiones Bosniak III y IV, para las clasificaciones vigentes y propuesta, en paciente sometidos a nefrectomía y la concordancia entre ambas clasificaciones. Materiales y métodos: Revisión retrospectiva de lesiones Bosniak III-IV halladas en TC o RM en pacientes mayores de 18 años sometidos a nefrectomía parcial o radical entre 2005 – 2020 en nuestro centro. Se excluyeron pacientes sin estudio histológico o sin imágenes disponibles en sistema. Resultados: Se incluyeron 52 pacientes. Se clasificaron Bosniak III 22 lesiones (42,3%) y Bosniak IV 30 lesiones (57,7%) con los criterios vigentes y 19 Bosniak III (36,5%) y 33 Bosniak IV (63,5%) con los criterios propuestos. El 86,4% de lesiones Bosniak III en la clasificación vigente (19 de 22) y el 93,3% de las Bosniak IV (28 de 30) obtuvieron resultado histológico maligno. Al aplicar la propuesta 2019, los porcentajes de malignidad fueron similares (84,2% y 93,9%) para ambas categorías. Según los criterios 2019 se reclasificaron 2 pacientes de Bosniak IV a III y 5 pacientes de Bosniak III a IV, con tasa de no concordancia de 13,5% (7 pacientes), estadísticamente significativa (p<0,0001). Conclusiones: Existe una tasa de no concordancia no despreciable entre la clasificación vigente y propuesta. Sin embargo, esto tiene escaso impacto en la predicción de malignidad, siendo muy similares para las lesiones Bosniak III y IV en ambas clasificaciones.Item Multisystem Inflammatory Syndrome in Children, Chile, May-August 2020(2021) Niño, Carmen; Otaola, Hugo; Lara, Natalie; Zuleta, Yuri; Ortiz, PaulaWe describe 26 children with multisystem inflammatory syndrome associated with coronavirus disease in the pediatric intensive care unit of Roberto del Río Hospital (Santiago, Chile). In total, 10 (38.5%) children required mechanical ventilation; 13 (50.0%) required inotropic support. In addition, 18 (69.2%) patients had echocardiographic abnormalities. No patients died.Publication Nefrectomía parcial robótica en tumores ≤ 3 cm. Complicaciones y resultados funcionales y oncológicos a largo plazo(2023) Otaola, Hugo; Mejías, Orlando; Krebs, Alfred; Lyng, Raúl; Orvieto, Marcelo; Zambrano, NormanObjetivo: Evaluar las complicaciones perioperatorias y los resultados funcionales y oncológicos a largo plazo en pacientes sometidos a nefrectomía parcial asistida por robot (NPAR) por masas renales pequeñas. Método: Se evaluaron pacientes sometidos a NPAR (daVinci Si) por tumores ≤ 3 cm por tomografía computarizada o resonancia magnética entre enero de 2004 y diciembre de 2021. Se excluyeron los pacientes con afectación linfonodal o metástasis en el diagnóstico inicial o en un seguimiento < 6 meses. Se revisaron las características basales, las complicaciones intra- y postoperatorias, la función renal y los desenlaces oncológicos. Los datos se extrajeron de la base de datos institucional retro- y prospectiva aprobada por el Comité de Ética. Resultados: De los 330 pacientes operados, 195 calificaron para el análisis (se excluyeron 21 por tener un seguimiento < 6 meses, 37 por haberse realizado por vía abierta y 93 por vía laparoscópica). La mediana de seguimiento fue de 53 meses. El tamaño medio del tumor en las imágenes preoperatorias fue de 19.2 mm. La media de tiempo quirúrgico fue de 131 min. La media de sangrado fue de 189 mL. Hubo 5 (2.6%) complicaciones intra- y 7 (3.5%) postoperatorias, tres de ellas Clavien III. Las tasas de reingreso y reintervención fueron del 2.6% y el 1.5%, respectivamente. El análisis histológico reveló carcinoma de células claras en el 61% (n = 119). Entre los factores desfavorables se encontraron grados nucleares 3 o 4 en 34 (17.4%), invasión linfovascular en 12 (6.2%), márgenes quirúrgicos positivos en 10 (5.1%) y necrosis en 10 (5.1%). Ningún paciente presentó patrón sarcomatoide. Ningún paciente presentó recurrencia local ni a distancia, ni mortalidad específica de cáncer. Dos pacientes fallecieron por otras causas (mortalidad global del 1%). A los 12 meses, la creatinina sérica media fue de 1.01 mg/dL y solo 6 pacientes (3.1%) presentaron una tasa de filtración glomerular estimada < 60 mL/minute/1.73 m2 de novo. Conclusiones: La NPAR en masas renales pequeñas es una técnica segura, con una excelente supervivencia a largo plazo y una buena preservación de la función renal en la mayoría de los pacientes.Item Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 Treated with Tocilizumab(2020) Niño, Carmen; Espinosa, Yazmín; Otaola, Hugo; Poli, Cecilia; Tapia, Lorena; Ortiz, PaulaWe describe a case of Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in an 8-year-old child. The patient developed multiorgan dysfunction, including mixed shock, cardiac dysfunction with myocarditis, pneumonia, acute kidney failure, and gastrointestinal involvement characterized by inflammation of the wall of the bowel and pancreatitis. After treatment with Tocilizumab and corticoid therapy, he presented clinical improvement and normalization of inflammatory markers. PIMS-TS is a new disease developed in a small percentage of patients, so a high degree of suspicion is necessary to establish the diagnosis. Supportive care is of paramount importance. The use of Tocilizumab to control the inflammatory response is likely to be beneficial, but the best immunotherapeutic agent has not yet been established. Randomized clinical studies should be run to determine the best treatment.Item Proper Use of the International Index of Erectile Function 5 (IIEF-5) Questionnaire in Patients Undergoing Transurethral Resection of the Prostate (TURP)(2022) Otaola, Hugo; Cabrera, Adriana; Niño, Carmen; Osorio, FranciscoBackground: Our goal was to show how the interpretation of the IIEF-5 questionnaire can lead to a significantly different outcome and propose a modification of the possible responses of the IIEF-5 questionnaire to assess erectile function after transurethral resection of the prostate (TURP). Methods: The results of patients treated with TURP in a randomized clinical trial were analyzed under four scenarios characterized by what patients to include and how to codify the answers for statistical interpretation: scenario (A) only patients who reported sexual intercourse; scenario (B) all patients, recording zero response for patients without sexual activity as one more grade of the scoring scale; scenario (C) same as B but coding 0 as “99” (missing value); and scenario (D) all patients are included, but the zero response remains as 0 for patients who reported not having had sexual intercourse due to the “Inability to penetrate (enter) the partner due to penile flaccidity”, whereas zero response is coded as “99” in those patients reporting “Inability to penetrate (enter) the partnerdue to other causes”. Results: Eighty-four patients qualified for the analysis. The proportion of patients in each ED category was verysimilar among the four scenarios, except for the “Severe ED” category. At baseline, scenario B had 36.9% of patients categorized as “Severe ED”, scenario D 18.5%, and scenarios A and C 17.2% (p < 0.01). This relative order remained constant in all postoperative visits. The differences in “Severe ED” rates were directly correlated with the inclusion of patients without sexual activity (higher “Severe ED” rate) and the codification of zero responses (when left as zero, they increase “Severe ED” rate, whereas when coded as 99 they are not included in the analysis and “Severe ED” rates decrease). Taking scenario D as a reference, we found a significant overestimation of “Severe ED” in scenario B up to 21.4% and a slight underestimation in scenarios A and B up to –15.7%. Conclusions: Using the IIEF-5 questionnaire with options 0 and 99 (scenario D) may improve the accuracy of detecting patients with “Severe ED” in the postoperative period of TURP. Clinical Trial Registration: NCT03936244 (https://clinicaltrials.gov/ct2/show/NCT03936244).Publication Successful extracorporeal membrane oxygenation therapy in a child with coronavirus 2019 disease-associated ARDS and chemotherapy for Ewing’s sarcoma(2022) Niño, Carmen; Zuleta, Yuri; Otaola, Hugo; Montenegro, Benigno; Sotomayor, Cristian; Greppi, Claudia; Silva, Pamela; Ortiz, PaulaMost children and adolescents with SARS-CoV-2 infection show no or mild symptoms, but those with medical histories can be susceptible to more severe forms of disease. There are few reported cases of extracorporeal membrane oxygenation (ECMO) in pediatric patients with coronavirus disease 2019 (COVID-19). We present a previously healthy 13-year-old male diagnosed with metastatic Ewing's sarcoma at the same time as catastrophic acute respiratory distress syndrome due to COVID-19, who was successfully supported by venovenous-ECMO while he received the corresponding chemotherapy protocol.ECMO can be used as salvage therapy in oncology pediatric patients with respiratory failure secondary to COVID-19. In addition, successful chemotherapy can be administered while patients are supported on ECMO.Publication The Management of Chylous Ascites: Description of a New Technique Regarding a Clinical Case(2023) Otaola, Hugo; Vargas, Patricio; Orvieto, Marcelo; Niño, Carmen; Bermúdez, HugoChylous ascites (CA) is a rare postoperative complication that can lead to malnutrition and immunodeficiency. As a result, surgical interventions are reserved for patients who are refractory, and the primary success factor for these interventions is locating the point of leakage, which is frequently difficult. Most CA cases were managed conservatively in the literature, with a minority treated with surgical intervention. We present the case of a 56-year-old man who developed chylous ascites following a laparoscopic radical nephrectomy and lumbo-aortic lymphadenectomy for kidney cancer. At first, the patient was managed with dietary changes and drainage placement. Following that, lipiodol lymphography, percutaneous embolisation of the leakage point, and total parenteral nutrition were established. Ultimately, after identifying the leakage point with methylene blue injection through an inguinal node, the patient underwent laparoscopic repair. The procedure was completed successfully, and no complications were reported. To improve the results of surgical repair of refractory chylous ascites in a subset of patients, intranodal methylene blue injection can be a beneficial technique for pinpointing the source of leakage.Item Totally intracorporeal robot-assisted urinary diversion for bladder cancer (Part 1). Review and detailed characterization of ileal conduit and modified Indiana pouch(2021) Otaola, Hugo; Coelho, Rafael; Patel, Vipul; Orvieto, MarceloObjective:To review the most used robot-assisted cutaneous urinary diversion (CUD) after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives, including new consistent images Methods: A non-systematic review of the literature with the keywords “bladder cancer”, “cutaneous urinary diversion”, and “radical cystectomy” was performed. Results: Twenty-four studies of intracorporeal ileal conduit (ICIC) and two of intracorporeal Indiana pouch (ICIP) were included in the analysis. Regarding ICIC, the patients’ age ranged from 60 to 76 years. The operative time to perform a urinary diversion ranged from 60 to 133 min. The total estimated blood loss ranged from 200 to 1 117 mL. The rate of positive surgical margins ranged from 0% to 14.3%. Early minor and major complication rates ranged from 0% to 71.4% and from 0% to 53.4%, respectively. Late minor and major complication rates ranged from 0% to 66% and from 0% to 32%, respectively. Totally ICIP data are limited to one case report and one clinical series. Conclusion: The most frequent type of CUD is ICIC. Randomized studies comparing the performance of the different types of CUD, the performance in an intra- or extracorporeal manner, or the performance of a CUD versus orthotopic ileal neobladder are lacking in the literature. To this day, there are not enough quality data to determine the supremacy of one technique. This manuscript represents a compendium of the most used CUD with detailed descriptions of the technical aspects, operative and perioperative outcomes, and new consistent images for each technique.Item Totally intracorporeal robot-assisted urinary diversion for bladder cancer (part 2). Review and detailed characterization of the existing intracorporeal orthotopic ileal neobladder(2021) Otaola, Hugo; Seetharam, Kulthe; Patel, Vipul; Covas, Marcio; Orvieto, MarceloAbstract: To review the most used intracorporeal orthotopic ileal neobladder (ICONB) after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives, including new consistent images. Methods: We performed a non-systematic review of the literature with the keywords "bladder cancer", "urinary diversion", "radical cystectomy", and "neobladder". Results: Forty studies were included in the analysis. The most frequent type of ICONB was the modified Studer "U" neobladder (70%) followed by the Hautmann "W" modified neobladder (7.5%), the "Y" neobladder (5%), and the Padua neobladder (5%). The operative time to perform a urinary diversion ranged from 124 to 553 min. The total estimated blood loss ranged from 200 to 900 mL. The rate of positive surgical margins ranged from 0% to 8.1%. Early minor and major complication rates ranged from 0% to 100% and from 0% to 33%, respectively. Late minor and major complication rates ranged from 0% to 70% and from 0% to 25%, respectively. Conclusion: The most frequent types of ICONB are Studer "U" neobladder, Hautmann "W" neobladder, "Y" neobladder, and the Padua neobladder. Randomized studies comparing the performance of the different types of ICONB, the performance in an intra or extracorporeal manner, or the performance of an ICONB versus ICIC are lacking in the literature. To this day, there are not sufficient quality data to determine the supremacy of one technique. This manuscript represents a compendium of the most used ICONB with detailed descriptions of the technical aspects, operative and perioperative outcomes, and new consistent images of each technique.